Resource Toolkit / Single Scheme Administration Project (Phase 1)
Death-in-Service Resources
Resource Name / Template Statement - Death Gratuity Benefit Statement
Resource Reference / SPS.DTH.DIS.TS.01(Phase 1)
Description / Death Gratuity Benefit Statement – this statement may be issued to the Legal Personal Representative of a deceased member’s estate showing the likely Death Gratuity benefit payable to the LPR and to assist in securing Letters of Administration/Grant of Probate
Version / V1.0
PLEASE NOTE: Administratorsmay accesslegislation, Circulars or Letters to Personnel Officers noted in this Procedure by accessing the Circulars & Legislation Section of the Single Scheme Website at

Single Public Service Pension Scheme

Death Gratuity Benefit Statement

(Death-in-Service)

issued by <insert Relevant Authority Name> on <dd/mm/yyyy>

Part A- Deceased Member Information

Deceased Member’s Name
Deceased’s PPS Number
Deceased’s Last Public Service Employer / <insert Relevant Authority Name>
Deceased’s Date of Birth / dd/mm/yyyy
Date of Death / dd/mm/yyyy
Deceased’s Civil Status prior to death / Single, Married, Civil Partnered,
Co-Habiting, Separated, Divorced, Widowed, Surviving Civil Partner, a former Civil Partner>
Pension Adjustment Order
(issued under the Family Law Acts)1 / <No OR Yes>

Part B - About your Statement

What is the purpose of this Statement?

This Statement is being issued following the Death-in-Service of the Single Public Service Pension Scheme member named in Part A above. It provides important information about the Death Gratuity amount that may be payable to the Deceased’s Legal Personal Representative upon our receipt of Letters of Administration/Grant of Probate. The information on this statement is based on informationprovided on the Single Pension SchemeMember Death Notification Formand any enquiries made by us following its receipt, as well as information held on our HR, Payroll and Pension records.

The contents of this statement should be read along with:

  • The information contained on the cover letter;
  • The enclosed Death-in-Service Benefits Information Note;
  • The Important Notes Section at the end of this Statement

What information does my Statement contain?

Your Statement contains information on the following:

Part A / This confirms the information that we hold in respect of the deceased. It should be reviewed to make sure that it is correct. If any information is not correct, you should make contact with the Pensions Officer (see Part E)
Part C / This provides details of the Death Gratuity amount that may be payable to the Legal Personal Representative and how it has been calculated. It shows the deceased member’s pensionable pay in the twelve-month period immediately prior to death and any deductions, if applicable, made from the gross Death Gratuity amount.
Part D / This provides information on how you can obtain further information and how to contact us in the event of that you have a query.
Part E / This provides some direction on who to contact if a Pensions Adjustment Order was issued by the Family Law Courts

Part C – Death Gratuity Benefit details

The Death Gratuity amount payable to the Legal Personal Representative, prior to any deductions or reductions for other lump sum entitlements from other Public Service Pension Schemes, is two times the Deceased’s pensionable pay received in the 12 months immediately prior to the date of death.

Pensionable pay used for Death Gratuity calculation [A] / €0.00
Gross Death Gratuity Amount 2 x [A] =[B] / €0.00
Less – Other Public Service Lump Sums payable [C] / €0.00
Less – Outstanding Contributions [D] / €0.00
Estimated Net Death Gratuity amount payable [B] – [C] –[D] / €0.00

Part D – What Single Scheme employments have been taken into account?

The table below shows the period(s) of Single Scheme public service employment(s) in respect of the deceased.

Single Scheme Employer / Period of Single Public Service Pension Scheme Membership
From / To
Most recent Public Service employer / <dd/mm/yyyy> / <Date of Death>
<Insert Former Employer Name> / <dd/mm/yyyy> / <dd/mm/yyyy>
<Insert Former Employer Name> / <dd/mm/yyyy> / <dd/mm/yyyy>

If you think that this information may not be correct, you should make contact with the Pensions Officer (see Part F)as soon as possible because the Death Gratuity amount may need to be reviewed.

Part E – If you have further queries

You should consult the documentation referred to in Part B of this Statement. If you still have queries, you should contact the Pensions Officer:

insert full contact details for Pensions Officer>

Part F –Important Notes

(Part A)1If a Pensions Adjustment Order has been issued by a Family Law Court and applies to the benefits under this Scheme, the benefits noted in this Statement make allowance for this. General information on Pension Adjustment Orders is also available from the Pensions Authority at

Disclaimer: In the event of a dispute the terms of the Public Service Pensions (Single Scheme and Other Provisions) Act 2012 and associated regulations shall apply.

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